What are the guidelines for lung cancer screening using Low-Dose Computed Tomography (LDCT)?

From the Guidelines

The current guideline for lung cancer screening recommends annual low-dose computed tomography (LDCT) scans for high-risk individuals, specifically adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. This recommendation is based on the evidence from the U.S. Preventive Services Task Force (USPSTF) 1 and is supported by other guidelines, including those from the American Cancer Society 1 and the American College of Radiology 1.

To implement this guideline:

• Assess patient's age, smoking history, and overall health status
• Discuss benefits and potential risks of screening
• Schedule annual LDCT scan if criteria are met
• Continue screening annually until the person turns 80, has not smoked for 15 years, or develops a health problem that significantly limits life expectancy

The age and smoking history criteria target those at highest risk, balancing the benefits of early detection against the risks of false positives and unnecessary procedures. LDCT is preferred over chest X-rays because it can detect smaller nodules and has been shown to reduce lung cancer mortality in high-risk populations 1.

Key considerations for clinicians include:

• Identifying high-risk patients who meet the screening criteria
• Discussing the benefits and risks of screening with patients
• Ensuring access to high-quality LDCT scans and follow-up care
• Encouraging smoking cessation and providing resources for patients who want to quit

By following this guideline, clinicians can help reduce lung cancer mortality and improve outcomes for high-risk patients.

From the Research

Guidelines for Lung Cancer Screening using Low-Dose Computed Tomography (LDCT)

• The US Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years 2.
• The American Cancer Society (ACS) also recommends annual lung cancer screening with LDCT for individuals aged 50-80 years who are asymptomatic but who currently smoke or have previously smoked 3.
• The USPSTF concludes with moderate certainty that annual screening for lung cancer with LDCT has a moderate net benefit in persons at high risk of lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking 2.

Eligibility Criteria

• Eligibility criteria for lung cancer screening with LDCT include age, cumulative pack-years, and years since quitting smoking (risk factor-based) or age and individual lung cancer risk estimation using risk prediction models with varying eligibility thresholds (risk model-based) 4.
• The USPSTF recommends screening for adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years 2.

Benefits and Harms

• Annual screening for lung cancer with LDCT is estimated to increase lung cancer deaths averted and life-years gained compared with no screening 4, 5.
• However, screening is also estimated to result in more false-positive test results, overdiagnosed lung cancer cases, and radiation-related lung cancer deaths 4, 5.
• Risk model-based strategies are estimated to be associated with more benefits and fewer radiation-related deaths but more overdiagnosed cases 4.

Implementation of Lung Cancer Screening Programs

• The implementation of a lung-cancer-screening program is complex and requires the involvement of a multidisciplinary team 6.
• Components and processes of a high-quality lung-cancer-screening program include the identification of eligible individuals, shared decision-making, performing and reporting LDCT results, management of screen-detected lung nodules and non-nodule findings, smoking cessation, ensuring adherence, data collection, and quality improvement 6.